Soo-Nyung Kim

Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis

BACKGROUND Growing evidence indicates that fish oil-containing lipid emulsions have a beneficial effect on parenteral nutrition-associated cholestasis (PNAC) in adults; however, data are limited in neonates regarding the effect of fish oil on PNAC. OBJECTIVE We conducted a meta-analysis of studies that addressed the effect of fish oil-containing lipid emulsions on reversing and preventing PNAC. METHODS We searched PubMed, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with the Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil-containing lipid emulsions. RESULTS Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil-containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil-containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil-based lipid emulsions. CONCLUSIONS The pooled data suggest that the use of fish oil-containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.

Effects of hormone replacement therapy on the rate of recurrence in endometrial cancer survivors: A meta-analysis

BACKGROUND To quantify the effect of hormone replacement therapy (HRT) on the recurrence in endometrial cancer (EC) survivors through a meta-analysis. METHODS A systematic literature review was conducted through October 2013 and included studies reporting estimates of effect size for the relationship between HRT use and the risk of EC recurrence. Study design features that may affect the selection of participants, the detection of EC recurrence and manuscript publication were assessed. If there was no significant statistical heterogeneity across studies, then a fixed effects model was used to obtain pooled estimates for the effect of HRT use on EC recurrence by combining study-specific estimates of the odds ratio (OR). RESULTS One randomised trial and five observational studies included 896 EC survivors who used HRT and 1079 non-users. Over the combined study period, 19 of the 896 HRT users experienced recurrence, whereas 64 of the 1079 controls did. The meta-analysis based on the fixed effects model indicates no significant increase in the risk of recurrence in EC survivors using HRT relative to the control group (OR: 0.53; 95% confidence interval: 0.30-0.96, I(2)=49.0). This pattern was also observed in the subgroup analysis for the stage and type of HRT. There was no evidence of any publication bias. CONCLUSIONS Although based mainly on observational studies, the literature does not provide support for a positive relationship between HRT use and the risk of EC recurrence. Future research should verify this relationship through randomised controlled trials over a longer term.

Efficacy of the pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: A meta-analysis†

The Pillar implant is one of the surgical options for snoring and obstructive sleep apnea (OSA). It is designed to be inserted into the soft palate to reduce vibration and collapsibility. The efficacy of the Pillar implant has been evaluated in various studies. However, only one study conducted a meta‐analysis of the findings, and was based on only three studies. We tried to get a more definite conclusion on the efficacy of the Pillar implant.

Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis.

[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words “muscle hypertonia OR spasticity” were used for spasticity, and the key words “shock wave OR ESWT” were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], −0.792; 95% confidence interval [CI], −1.001 to −0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, −0.735; 95% CI, −0.951 to −0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.

Early Caffeine Use in Very Low Birth Weight Infants and Neonatal Outcomes: A Systematic Review and Meta-Analysis

The use of caffeine citrate for treatment of apnea in very low birth weight infants showed short-term and long-term benefits. A systematic review and meta-analysis of the literature was undertaken to document the effect providing caffeine early (0-2 days of life) compared to providing caffeine late (≥3 days of life) in very low birth weight infants on several neonatal outcomes, including bronchopulmonary dysplasia (BPD). We searched MEDLINE, the EMBASE database, the Cochrane Library, and KoreaMed for this meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Jadads scale. Studies were included if they examined the effect of the early use of caffeine compared with the late use of caffeine. Two reviewers screened the candidate articles and extracted the data from the full-text of all of the included studies. We included a total of 59,136 participants (range 58,997-59,136; variable in one study) from a total of 5 studies. The risk of death (odds ratio [OR], 0.902; 95% confidence interval [CI], 0.828 to 0.983; P=0.019), bronchopulmonary dysplasia (BPD) (OR, 0.507; 95% CI, 0.396 to 0.648; P<0.001), and BPD or death (OR, 0.526; 95% CI, 0.384 to 0.719; P<0.001) were lower in the early caffeine group. Early caffeine use was not associated with a risk of necrotizing enterocolitis (NEC) and NEC requiring surgery. This meta-analysis suggests that early caffeine use has beneficial effects on neonatal outcomes, including mortality and BPD, without increasing the risk of NEC.

Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis.

Background Chorioamnionitis has recently been reported as a risk factor for various neonatal diseases, including cerebral palsy, bronchopulmonary dysplasia, and necrotizing enterocolitis, but its effect on patent ductus arteriosus (PDA) is unclear. We performed a systematic review and meta-analysis to evaluate the effect of chorioamnionitis on PDA. Methods We searched PubMed, EMBASE, Cochrane Library, and KoreaMed databases using the terms: “intrauterine infection” or “maternal infection” or “antenatal infection” or “chorioamnionitis” or “placenta inflammation” or “placenta pathology” or “neonatal outcome” or “neonatal morbidity” or “PDA or patent ductus arteriosus” or “ductus arteriosus,” and “prematurity” or “very low birth weight infant.” Studies were included if they were randomized controlled trials, case–control studies, or cohort studies that included information relating to chorioamnionitis and PDA. Results Among 1,571 studies, a total of 23 studies (17,708 cases) were included in the meta-analysis to analyze the relationship between chorioamnionitis and PDA, except one study that only included PDA requiring surgical ligation. The association between chorioamnionitis and PDA was statistically significant (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.19, 1.72; P < 0.0001). In subgroup analysis, clinical chorioamnionitis was not associated with PDA (OR 1.28; 95% CI 1.00, 1.64, 1.790; P = 0.05), whereas histologic chorioamnionitis (OR 1.54; 95% CI 1.10, 2.15; P = 0.01) and chorioamnionitis diagnosed from both clinical and histologic findings (OR 1.75; 95% CI 1.07, 2.86; P = 0.03) showed significant associations with PDA. Chorioamnionitis did not increase the risk of PDA requiring surgical ligation (OR 1.23; 95% CI 0.69, 2.17; P = 0.48), and antenatal steroid use reduced the risk of PDA (OR 0.62; 95% CI 0.42, 0.90; P = 0.01) after chorioamnionitis. Conclusions The results from this meta-analysis support an association between maternal chorioamnionitis and PDA in offspring.

Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients

OBJECTIVE Accurately predicting cytoreducibility in advanced-ovarian cancer is needed to establish preoperative plans, consider neoadjuvant chemotherapy, and improve clinical trial protocols. We aimed to develop a positron-emission tomography/computed tomography-based nomogram for predicting incomplete cytoreduction in advanced-ovarian cancer patients. METHODS Between 2006 and 2012, 343 consecutive advanced-ovarian cancer patients underwent positron-emission tomography/computed tomography before primary cytoreduction: 240 and 103 patients were assigned to the model development or validation cohort, respectively. After reviewing the detailed surgical documentation, incomplete cytoreduction was defined as a remaining gross residual tumor. We evaluated each individual surgeons surgical aggressiveness index (number of high-complex surgeries/total number of surgeries). Possible predictors, including surgical aggressiveness index and positron-emission tomography/computed tomography features, were analyzed using logistic regression modeling. A nomogram based on this model was developed and externally validated. RESULTS Complete cytoreduction was achieved in 120 patients (35%). Surgical aggressiveness index and five positron-emission tomography/computed tomography features were independent predictors of incomplete cytoreduction. Our nomogram predicted incomplete cytoreduction by incorporating these variables and demonstrated good predictive accuracy (concordance index = 0.881; 95% CI = 0.838-0.923). The predictive accuracy of our validation cohort was also good (concordance index = 0.881; 95% CI = 0.790-0.932) and the predicted probability was close to the actual observed outcome. Our model demonstrated good performance across surgeons with varying degrees of surgical aggressiveness. CONCLUSION We have developed and validated a nomogram for predicting incomplete cytoreduction in advanced-ovarian cancer patients which may help stratify patients for clinical trials, establish meticulous preoperative plans, and determine if neoadjuvant chemotherapy is warranted.

Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis

BACKGROUND To quantify the effect of complete surgical staging (CSS) on prognosis in borderline ovarian tumour (BOT) patients through a meta-analysis. METHODS We systematically reviewed published studies comparing CSS with incomplete surgical staging (ISS) in BOT patients through April 2015. End-points were recurrence and mortality rates. Study design features that possibly affected participant selection, recurrence/death detection, and manuscript publication were assessed. For pooled estimates of the effect of CSS on recurrence/death, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. RESULTS Eighteen observational studies (CSS, 1297 patients; ISS, 1473 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated a reduced recurrence risk among CSS patients (odds ratio [OR]=0.64; 95% confidence interval [CI]: 0.47-0.87, P < 0.05, I(2) = 25.6). However, no significant between-group difference in mortality was observed (OR = 0.98; 95% CI: 0.42-2.29, P = 0.97, I(2) = 0). In subgroup analysis by histology, CSS was associated with a reduced recurrence risk in 16 studies of all histologic types (OR = 0.66; 95% CI: 0.48-0.91, P < 0.05, I(2) = 31.9) but not in two studies of only mucinous disease (OR = 0.41; 95% CI: 0.13-1.30, P = 0.13, I(2) = 0). In subgroup analyses with four studies with recurrence data according to fertility-sparing surgery, no significant association was found (OR = 0.51; 95% CI: 0.18-1.43, P = 0.20, I(2) = 0). There was no evidence of publication bias. CONCLUSIONS In this meta-analysis based on observational studies, CSS appeared to significantly reduce recurrence among BOT patients. No survival impact was observed. Longer-term randomised controlled trials could verify this relationship but appear infeasible for this rare tumour.

Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis.

Objective Uvulopalatopharyngoplasty (UPPP) remains one of the most common surgical treatments for patients with obstructive sleep apnea. However, the results after UPPP are unpredictable. The purpose of this meta-analysis is to identify predictors of success after UPPP. Data Sources A literature search was performed utilizing PubMed, EMBASE, SCOPUS, and the Cochrane Library. Review Methods The keywords and medical subject heading terms used were uvulopalatopharyngoplasty and UPPP. Studies were included if UPPP was used as a single surgical procedure for the treatment of obstructive sleep apnea and results were presented separately as responder (surgical success) and nonresponder (surgical failure). Exclusion criteria included pediatric patients and other surgical procedures (eg, nasal and hypopharyngeal) performed at the same time as the UPPP. Age, body mass index, preoperative apnea-hypopnea index, Friedman stage, and several cephalometric variables were compared between responders and nonresponders. Results A total of 1257 studies were screened, with 15 studies included in this meta-analysis. Our results demonstrate that Friedman stage I is a strong predictor for success after UPPP, while Friedman stage III and low hyoid position are negative predictors. Age, body mass index, preoperative apnea-hypopnea index, and other cephalometric measurements were not significant. Conclusion Friedman stage and hyoid position are important predictors for UPPP.

Does salpingectomy have a deleterious impact on ovarian response in in vitro fertilization cycles

OBJECTIVE To investigate the impact of salpingectomy in patients with IVF treatment on ovarian response. DESIGN Meta-analysis. SETTING Not applicable. PATIENT(S) Patients under treatment for infertility, during the cycles before and after treatment by salpingectomy for hydrosalpinx or ectopic pregnancy. INTERVENTION(S) PubMed, MEDLINE, EMBASE databases, and CENTRAL in Cochrane Library up to July 2015. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. The subgroup analysis was planned a priori before data were collected and analyzed. MAIN OUTCOME MEASURE(S) The amount of gonadotropin administered, the peak E2 level, the number of oocytes retrieved, and the number of pregnancies. RESULT(S) After the final screening, 12 of the studies were retrospective and six were prospective. In this meta-analysis, 1,482 patients were enrolled, including a total of 657 patients with salpingectomy and 825 without salpingectomy. The comparisons before and after salpingectomy of the peak E2 level (standardized mean difference [SMD] = -0.182; 95% confidence interval [CI], -0.166, 0.101; I2, 85.45%), the total gonadotropin dose used for stimulation (SMD = 0.127; 95% CI, -0.054 0.308; I2, 84.49%), and number of oocytes retrieved (SMD = -0.060; 95% CI, -0.189, 0.070; I2, 63.93%) did not reveal any significant differences. The number of pregnancies before and after salpingectomy did not differ significantly (odds ratio [OR] = 1.180; 95% CI, 0.854, 1.630; I2, 34.01%). CONCLUSION(S) Salpingectomy in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive.